Provider Demographics
NPI:1457097206
Name:TARABUS, NINA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:TARABUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 3RD AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5135
Mailing Address - Country:US
Mailing Address - Phone:708-362-9102
Mailing Address - Fax:
Practice Address - Street 1:1306 NW HOYT ST STE AND407
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2731
Practice Address - Country:US
Practice Address - Phone:971-407-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110483-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health